"Pollution itself never shows up on death
certificates," laments environmental health expert Devra
Davis, MPH '82. Her celebrated new book, rooted in a
dramatic childhood experience, is a clarion call for
immediate policy reform.

Halloween week, 1948. Thick fog hovers above a sleepy
Pennsylvania steel mill town, not far from Pittsburgh.
Plugged between ridges of Allegheny mountains, the fog acts
like a cork bottling the valley while zinc and iron plants
along the Monongahela River churn away, spewing plumes of
smoke into the air. Cut to the scene of a Halloween parade
creeping through town as costumed children materialize like
ghosts out of an eerie haze and disappear again. Life goes
on as usual, but two days before All Hallow's Eve, the fog
weighs heavily, the smokestacks belch vehemently, and
darkness falls... at noon.

On Halloween day, officials finally decide to shut down the
zinc works.

By then, half the town's population had fallen ill and 18
people had died, in what the media dubbed a "killer
smog."

The scenario could very well be the latest script treatment
by Pittsburgh-area native George A. Romero, virtuoso of
modern horror films and father of all things zombie.
However, the events described actually happened, and they
form the epicenter of another Pennsylvania native's first
book, When Smoke Ran Like Water: Tales of Environmental
Deception and the Battle Against Pollution (Basic
Books).

The book, by Devra Davis, MPH '82, renowned for her studies
of the environmental causes of breast cancer, is part
science, part exposé, part memoir, and part clarion
call for immediate policy reform. In a rare achievement for
a first book, it vied for last year's National Book
Award.

In When Smoke Ran Like Water, Davis ushers readers
from accounts of cities choked by catastrophic levels of
pollution (the central episode being Davis' hometown);
through a primer on the work of exceptional scientists
before her (such as Mary Amdur, the "mother of modern
toxicology"); into a maze of political bureaucracy and
nefarious corporate tactics (using as examples the
automobile industry in general and, in particular, the
Ethyl Corporation's fight to keep lead in gasoline despite
evidence of its hazards). Davis concludes with the ironic
realization that as her own political status grew, her
ability to enact real change diminished -- prompting her to
leave government service for academia.

Davis grew up in Donora, a town of 14,000 nestled in a bend
of the Monongahela about 25 miles south of Pittsburgh. In
October 1948, when she was just two years old, an inversion
layer -- descending cold air that prevents warm air from
rising -- flooded the valley. Hot exhaust fumes from mills,
furnaces, and stoves could not dissipate above the
hilltops. They eventually cooled and settled back to the
ground. A photograph from the Pittsburgh
Post-Gazette depicts Main Street at noon on October 29,
1948, with streetlights brightly lit. Meanwhile, officials
at the Donora Zinc Works, a holding of the U.S. Steel
Corporation, continued production, emitting gases that had
nowhere to go.

People [in the town of Donora] literally asphyxiated. In
a 12-hour period, 18 people died. Within a month, about 70
had died. The town funeral parlor ran out of
caskets.

People literally asphyxiated. In a 12-hour period, 18
people died. Another two deaths occured within five days.
Within a month, about 70 people had died. The town funeral
parlor ran out of caskets.

Davis is now a visiting professor at Carnegie Mellon
University's H. John Heinz III School of Public Policy and
Management. Ironically, she had left Donora before she
learned about the calamity that had occurred there. "It
wasn't until I was 17 at the University of Pittsburgh when
I heard people talk about it [the 1948 smog]," Davis
recalls.

In the book, she recounts a conversation with her mother
about the possibility of there being other Donoras, the way
there are other Pittsburghs and several Allentowns. Surely
what she had read at school couldn't have been about her
bucolic hometown.

"People just didn't talk about it," Davis says, admitting
that only recently has her mother acknowledged a possible
connection between Donora's pollution and her own cardiac
ailments.

Every one of Davis' maternal grandmother's children
developed heart problems. Over the course of 18 months in
the mid-1940s, Bubbe Pearl deteriorated from being a
vivacious matriarch to an invalid. Davis' fit and active
Uncle Len died at age 50 from cardiac arrest. By the same
age, her mother, Jean, had undergone three bypasses. Aunt
Gert required two angioplasties. But none of their
illnesses -- or the causes of death for those who died --
were linked to the place where they grew up and lived.
These family members, and the thousands they represent
whose terminal illnesses directly result from toxins
percolating in pollution, comprise the "uncounted."

Davis laments how "pollution itself never shows up on death
certificates." This oversight serves as the book's
momentum. She writes: "The fifty people who died in the
month following the smog are nowhere counted. The thousands
who died over the following decade are nowhere counted. And
there is no counting of the thousands... called the
non-killed -- all those who went on to suffer in various
poorly understood ways."

For Devra Davis, counting counts. She specializes in
epidemiology -- the science of diseases' frequency, spread,
and control among populations -- which is rooted in
numbers: counting incidences, analyzing data, extrapolating
patterns from stacks of statistics, and often contributing
to policy decisions.

The manuscript that developed into the book was originally
titled "Reckonings: The Education of a Numbers Woman." Each
chapter of When Smoke Ran Like Water leads with an
epigraph from sources ranging from Maimonides to Bella
Abzug, from Charles Dickens to Roger Daltrey. Her favorite
quote comes from Albert Einstein: "Not everything that can
be counted, counts. Not everything that counts, can be
counted."

Einstein's words capsulize Davis' work.

The 56-year-old has penned more than 170 peer-reviewed
articles and popular pieces that have appeared in venues
ranging from Journal of the American Medical
Association, Lancet, Science, and Reproductive
Toxicology, to the New York Times, the
Washington Post, and the Los Angeles Times.
She has held ringside seats to the environmental health
debate as a senior adviser to the assistant secretary of
health during the Clinton administration, a presidential
appointee to the National Chemical Safety and Hazard
Investigation Board, and as director and senior scientist
of the World Resources Institute's Health, Environment, and
Development Program, which she founded in 1995.

As executive director of a committee with the National
Academy of Sciences (NAS) in 1983, Davis established
parameters for a four-year, $500,000 study of smoking on
airplanes. Before the study got started, she borrowed an
ominous chunk of scientific equipment (a piezobalance) and
tucked it under her grandmother's old mink coat during a
cross-Atlantic flight. The aerosol monitor measures the
weight of airborne particles as small as those produced by
cigarette smoke. In one eight-hour flight, Davis determined
what her committee would formally conclude four years
later: identical levels of particles existed in the plane's
smoking and non-smoking sections. Less than a year after
the NAS report was published, smoking bans took effect on
airplanes and in other public places.

The Donora Wire Mill in 1910 when the town was barely
settled.

Constantly on the go, Davis divides time between Jackson,
Wyoming; Pittsburgh; and Washington, D.C. (where husband
Richard Morgenstern, a former lead economist at the EPA, is
senior fellow at Resources for the Future). She has emerged
as a cross-over scientist who is capable of translating
complex research into digestible information for public
consumption -- via National Public Radio, CBC Radio, and
CBS's 60 Minutes.

"She's not drab," says Lester Lave, professor of economics
and finance at Carnegie Mellon University's Graduate School
of Industrial Administration. An economist who pioneered
changes in environmental health research 30 years ago,
Lave's work is cited often in When Smoke Ran Like
Water. The two researchers met during stints at the
National Academy of Sciences.

"Devra knows how to get people to pay attention," he says.
"She focuses on the important problems, recruits the best
authors and experts to work with, and gets attention with
effective write-ups presented to the public and policy-
makers."

A packrat by nature, Davis had for years accumulated towers
of notes and mounds of material that became parts of
When Smoke Ran Like Water. However, she says that
the book would have been impossible without the treasure
trove of documentation available on government Web sites,
old-fashioned "shoe leather librarian skills," and a group
of talented young researchers who helped in conducting
large-scale analyses and background sleuthing.

One such researcher is Michelle Bell, PhD '02, who first
made contact with Davis after reading an article she had
written about the indirect effects of climate change on
human health. The two women discovered similar research
interests and Davis sat on Bell's dissertation committee in
Hopkins' Department of Geography and
Environmental Engineering. Bell, now researching the
effects of air pollution on health at Hopkins'
Bloomberg School of Public
Health, collaborated with Davis on researching one of
the world's worst environmental disasters, an inversion
smog in London. That "extreme" episode, which became known
as "the Great Killer Smog of 1952," brought "the connection
between air pollution and health to the attention of the
government, public, and scientific community," Bell says.
Bell and Davis discovered correlations between health
indicators and air pollution concentrations, as well as
lingering adverse health effects. Over the course of four
months (December 1952 to March 1953), 13,000 more people
died than would have been expected, given historical
averages. In one week alone, 4,703 Londoners died (a
drastic increase compared to the 1,852 who died during the
same week the previous year). The duo's findings squelched
accepted notions that the increased mortality rate had
resulted from influenza. Their work was published in
Environmental Health Perspectives and became the
basis of a chapter in Davis' book, in which the author
wrote that in 1952 London, "smoke ran like tap water from a
million chimneys."

Says Bell, "Devra is different from some other scientists
in that she is interested in all aspects of the problem --
data analysis, historical records, sources of pollution,
modern policy implications -- which allows her to work on a
variety of projects with people from diverse academic
backgrounds."

After 20 years as an epidemiologist, Davis felt confident
with handling the science when she set out to write her
book. Weaving a narrative appropriate for general readers
proved much more challenging, she says, because she ran the
risk of alienating scientists and policy leaders who might
find the science somehow less rigorous. "There's a fine
line between being glib and getting the science right
without being so technical," she says.

Drawing inspiration from Midrashic tradition, where rabbis
interpret biblical literature for contemporary audiences,
Davis employs the tool of storytelling. Throughout an
examination of the connection between widely used chemicals
like PCBs and DDT and exploding rates of breast cancer, and
a general explanation of how epidemiologists go about
counting breast cancer statistics, Davis laces stories of
women who battled the disease, including environmentalist
Rachel Carson, MA '32, and friend Bella Abzug, the New York
congresswoman and women's rights advocate who died from
breast cancer in 1998.

"Breast cancer research is at a crossroads that may not be
apparent to those in the thick of it," Davis writes. "The
millions allocated to research have produced what one
editor of the Lancet describes as a glut of same
old, same old studies. Different questions must be asked to
break the logjam. For women confronting breast cancer
today, the central question remains this: What avoidable
factors cause 19 out of 20 cases of the disease?"

"I have a great respect for the rigors and demands of
science, but I also understand the limits of what another
article in JAMA, Lancet, or Science can do,"
says Davis.

Faith is absolutely critical in Davis' work as a scientist,
and a deeply spiritual vein runs through her book. "I am a
scientist," she writes. "I am also religious."

"One can get discouraged with all that is going on in the
world today with so many things you can't control," she
says. "It can be difficult to come to terms with those
things. Being a person of faith provides a certain comfort
knowing that you may not always succeed, but you will
always try."

Even with her faith, she admits to becoming frustrated when
battling the bureaucratic quagmire. "The effort to
establish the science of environmental epidemiology has
been plagued by a sophisticated and completely legal
disinformation campaign, the full extent of which is not
appreciated even by those who have been its chief victims,"
she writes.

As an example, she points to what she describes as the
"insidiously slow" process it takes to get harmful chemical
agents listed in the Annual Report of Carcinogens, a
"reverse Academy Awards system for chemicals," whose
designation companies aggressively attempt to avoid.

In When Smoke Ran Like Water, she points as one
example to trichloroethylene (TCE), used widely by American
industry as an additive to household products such as paint
removers, adhesives, and various cleansers. Going all the
way back to the 1950s, toxicological studies have pointed
to the danger TCE holds for humans, Davis notes, but years
of legal wrangling and controversy prevented any progress
from being made. Then, in the 1980s, two families living
near a Xerox manufacturing plant in Rochester, New York,
received a multi-million dollar settlement on a suit
claiming that TCE contaminated their land and caused cancer
in a five-year-old girl. The settlement's conditions
included closing the health records, sealing possibly vital
information from researchers' view, and forging, as the
Washington Post reported in 1989, a "covenant of
silence."

For the most part, animal studies had shown links between
exposure to TCE and biological consequences. The question
remained as to what extent studies with animals and cell
cultures conveyed to effects in humans. Ultimately, as
Davis reports in her book, epidemiologists enlisted by the
Halogenated Solvents Industry Alliance (which represented
Dow Chemical and others makers of TCE) responded to the
specific question of whether human studies alone proved
that TCE caused cancer. Their response: research to date
showed "no consistent evidence of a relationship with
cancer." The National Toxicology Program, which rules on
which chemicals should be designated as carcinogens,
agreed.

TCE (and other similarly hazardous chemicals) remains
unlisted as a human carcinogen. And annually in the United
States and Europe, 300,000 people die from
pollution-related causes, her book relates.

In his review of When Smoke Ran Like Water for
Reason, Todd Seavey -- editor of
healthfactsandfears.com, a webzine published by the
American Council on Science and Health -- suggests that
Davis wants her readers to "fear that mass death caused by
pollution may be going on all around us on a regular basis"
and that she wants "fear to haunt us whether or not the
hard numbers exist to prove that the fear is warranted."
Such fear is unwarranted, he argues, because not enough
epidemiological studies involving humans have been
conducted to justify the costs of policy change and
corporate retooling. He calls Davis' tactics "green
politics masquerading as environmental science."

"Devra is not Chicken Little," says Carnegie Mellon's Lave,
"because she pays attention to the science."

He adds, "Science is not always fully certain, but there is
a lot of data and it would be imprudent not to act on it.
We have choices: either wait and regret not acting sooner
or act with the possibility of going too far. It's a
delicate balance between the social ills of premature
action and the ramifications of not acting at all."

During London's killer smog in December 1952, visibility
was less than 30 feet. Buses were led by policemen with
flares.

Forty years after the Donora smog, Davis survived another
disaster that provided the final impetus to write her
book.

Davis recalls the place and date exactly: Athens, September
7, 1999. She had traveled to Greece for an international
conference on public health, where she would present her
first paper on Donora. But before she could get to the
conference center, a violent 30-second earthquake rocked
the city, trapping her in a hotel elevator. She freed
herself, but later discovered that nearly 140 people had
died and 100,000 were left homeless.

"To survive an experience where other people died, that
made it clear that I better write this [book] while I
could," she says.

After the quake, the conference resumed and Davis delivered
her paper. The reaction of attendees astonished her. Victor
Borja-Aburto, a researcher with Instituto Nacional de Salud
Publica working on Mexico City's horrendous pollution
problem, approached her, as did a colleague from China whom
she declines to identify. "They pleaded with me to tell the
story so that their countries would hear it, so that
officials would understand that current patterns of air
pollution are a serious threat to people in their
country."

There is evidence that her message has found a receptive
audience. John Topping, president of the Climate Institute,
calls When Smoke Ran Like Water "the best book on
the environment since [Rachel Carson's ] Silent
Spring." Davis balks at comparisons to Carson, but
striking similarities link the two women right down to
their shared Hopkins affiliation. Both were born in river
towns not far from Pittsburgh. Exactly 50 years separated
the time Carson earned her master's degree at Hopkins and
Davis hers. Carson won the National Book Award in 1952 for
The Sea Around Us while Davis' book ranked as a
finalist in 2002.

Davis is quick to note that their careers actually took
quite different paths. "Carson did not spend 20 years of
her life writing peer-reviewed papers and articles," says
Davis. "She was always interested in writing for a broader
audience and did a phenomenal job. I am much more of a
novice at that; she was much more skilled."

Signs indicate that Davis' tenure as novice might be
short-lived. Basic Books reports that When Smoke Ran
Like Water is in its third printing. Davis is currently
at work on a new book, slated for publication sometime in
2004. It will deal more specifically with workplace hazards
and draw from her days at Hopkins' public health school,
where she had studied with Abraham Lilienfeld, widely known
as the "father of contemporary chronic disease
epidemiology." Lilienfeld made significant contributions to
studies establishing links between smoking and serious
health risks.

Davis hopes that her late mentor would have been pleased
by her book's being named a National Book Award
finalist.

True to form, she calculated the probability of winning the
award by giving fellow finalist and heavyweight biographer
Robert A. Caro a grade of 5 and all others including
herself a grade of 0.5. Caro, stiff competition with a
Pulitzer Prize already to his credit, was nominated for
Master of the Senate, the eagerly anticipated third
volume in his Lyndon Johnson biography.

"Several of the other nominees had written [acceptance]
speeches," she notes. "I didn't."

Caro won.

The source of the poison in Donora was never formally
identified, although a consensus of opinion suggests it was
toxic fluoride gas emitted from the mills. In 1948, the
United States was still emerging from the shadow of wars
and steel girded the country's return to prosperity. For
obvious reasons, U.S. Steel wanted to put the incident
behind it as quickly as possible, as did workers with
families to support. U.S. Steel's records still remain
closed to researchers and investigators.

The U.S. Public Health Service launched an investigation,
but it also wanted to usher in a quick return to normalcy.
It published just one inconclusive report on the incident
and the matter received little official attention for years
afterward. Ultimately, however, the tragedy served as the
first evidence in the United States that air pollution
could kill. Today, some point to the deadly Donora smog as
one event that led to the Clean Air Act of 1970 and the
formation of the Environmental Protection Agency.

Donora's story almost went unheard. While Davis has no
intention of abandoning her quotidian job as a scientist,
she does plan to incorporate storytelling into her future
work as a writer. "I have a great respect for the rigors
and demands of science, but I also understand the limits of
what another article in JAMA, Lancet, or
Science can do," she says. "There are a number of
issues that still require serious scientific work, but I
also think it is time to do a better job of telling the
story so that people will understand that there's more we
can do to protect ourselves."